Educators, health officials facing logistical challenge

Thousands of American schools are mobilizing to ensure that students are vaccinated against swine flu in the coming weeks, a task complicated by parental fears and overlap with vaccine programs for seasonal flu.

Public-health officials say the swine-flu season is in full swing, and in fact has never stopped since the new virus, known as H1N1, was identified in April. Children have been among the groups hardest hit. A total of 86 children in the United States have died from swine flu, the federal Centers for Disease Control and Prevention said last week. Forty-one states are reporting widespread swine flu, the Atlanta-based CDC said.

As the first doses of the vaccine are distributed this month, health and school officials are focusing on helping to get children inoculated. People between the ages of 6 months and 24 years are among the “priority groups” recommended to receive the swine-flu vaccine. And health officials say they should also be vaccinated against regular, seasonal flu, which typically is more dangerous for older people.

For schools, the effort has meant collaborating with local health departments, anticipating when shipments of swine-flu vaccine will arrive, sending consent forms to parents, and trying to get families’ questions answered so the forms can be returned quickly.

‘A Race’

“This flu never went away,” said Amy Garcia, the executive director of the National Association of School Nurses, based in Silver Spring, Md. “A lot of school nurses who worked in summer school programs spent the whole summer taking care of the swine flu.

“It is a race to get the vaccine to children,” she said. “We’ve got parents who say it’ll be too late for the vaccine, because the flu is already here. I would say this flu is not going away without vaccine and other kinds of containment.”

The fact that vaccination programs for swine flu are coinciding with the time of year that regular flu-vaccine campaigns take place is creating a double challenge for schools and public-health officials.

Children younger than 10 will require two doses of the H1N1 vaccine, a month apart, to provide effective immunity. In large school districts, that means that by the time the students at the last school to hold a vaccine clinic are getting the first shot, students at the first school to hold a vaccine clinic already need the second shot, Ms. Garcia said.

The 142,000-student Montgomery County, Md., school district suspended its school-based clinics for seasonal-flu vaccine because of inadequate supply of that vaccine, and to make way for the swine-flu vaccine, which was shipped sooner than expected.

Mary Anderson, a spokeswoman for the Montgomery County Department of Health and Human Services, said a letter dated Oct. 5 about the canceled clinics to be held in schools went home to parents. That sent parents then scrambling for doctor appointments or to seek out county seasonal-flu-vaccine clinics on short notice.

With the injected versions of the vaccines, children can receive the shots for both seasonal and swine flu at the same time. But the county’s seasonal-flu-vaccine clinics were offering the FluMist nasal spray, so children would have had to wait 28 days to receive a swine-flu-vaccine mist, Ms. Anderson said. That timing would have meant that some students wouldn’t have been able to get the swine-flu nasal vaccine until the end of November.

“Young kids are the most efficient spreaders of the disease,” Ms. Anderson said. “We want to get to them as quick as possible.”

Since the start of the new school year, more than 400 schools around the nation have closed because of swine flu, affecting 75,000 students, Mr. Hamilton of the federal Education Department said. Schools were quicker to close last spring, when less was known about the virus. Since then, the Education Department has issued guidance to schools saying they should shut their doors only when it’s absolutely necessary, Mr. Hamilton noted.

“The best place for children to be is school,” he said. “We have to keep them safe, healthy, and learning. If you can keep most of the people in the building safe and healthy, and separate folks who are sick and keep them at home, then school should stay open.”

Ms. Garcia of the school nurses’ association said health officials realize that schools have a role in spreading the virus, but are by no means the only place children could acquire it.

“We go to team sporting events, church, parties, do holiday travel, go to the mall,” she said. “We share viruses.”

Parents’ Roles

Health and education officials also say they must educate parents about the swine-flu vaccine and secure their permission before administering it to students.

To receive the vaccines, students must have consent forms signed by their parents. But it’s hard to get back consent forms for field trips, much less for something like a vaccine, Ms. Garcia said. If it takes a while for parents to have questions or concerns addressed, it could delay their returning the consent forms on time, she said. Adding to the paperwork challenge, there is often not a lot of turnaround time for consent forms, with the vaccine supplies arriving on short notice.

The swine-flu outbreak, which is considered a pandemic, also has highlighted the need for centralized record-keeping and immunization databases, Ms. Garcia said.

“There are so many issues of logistics, getting the right amount of vaccine at the right time so the right people can give it to the right kids,” she said.

One of the nation’s first school-based vaccination clinics for swine flu was held Oct. 9 at Dodge Park Elementary School in Prince George’s County, Md., a suburb of Washington. U.S. Secretary of Education Arne Duncan, U.S. Secretary of Health and Human Services Kathleen Sebelius, Maryland Gov. Martin O’Malley, and Jay Butler, the director of the CDC’s H1N1 Vaccine Task Force, touted the importance of flu prevention for children and parents.

But parents of students at the school had less than 48 hours to return consent forms, Ms. Garcia said, and only 20 percent were returned in time.

Some parents have heightened concerns because they believe the swine-flu vaccine is new, even though it is made the same way as seasonal-flu vaccines, health officials have stressed.

Also, some parents worry that thimerosal, the mercury-based preservative used in vaccines, has led to a rise in autism cases. Many studies have refuted such a link.

The mist version does not contain thimerosal, and there are some swine-flu-vaccine injections available without thimerosal that parents can seek out if they are concerned, Ms. Garcia said.

Victoria Holmes, the assistant principal of Dodge Park Elementary, said parents were probably hesitant to sign the forms because the swine-flu vaccine is new.

“It’s important to make sure families are aware that the school is offering the vaccines on a voluntary basis,” Ms. Holmes said. “The school system is not forcing anyone.”

The clinic went smoothly, the principal said, and none of the children vaccinated has reported any side effects. “The kids were a little nervous,” she said, “but they did well.”

Vol. 29, Issue 08, Page 6

Published in Print: October 21, 2009, as Schools Taking Part in Campaign to Give Swine-Flu Vaccine

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